HELMS Framework

Given Given Login into "Salesforce" as "Admin"

Logged in to Salesforce with user :: Admin

passed

And And Navigate to "Accounts" tab

passed

And And From the available list views, Select the "All Accounts" list view

Selected list view :: All Accounts

passed

And And Click on "Automation Test" Hyperlink

passed

And And Click on "Show more actions" button

clicked on the button :: Show more actions

passed

And And Click on "Log in to Experience as User" Hyperlink

passed

And And Verify user has navigated to "Welcome to State of Washington HELMS" page

passed

And And Click on "Start A New Application" button

clicked on the button :: Start A New Application

passed

And And Verify user has navigated to "Select License" page

passed

And And Fill the below details :

Field Name	Data Type	Value
Program	Dropdown	Medical Commission
Professions	Dropdown	Physician and Surgeon
Physician And Surgeon Residency License	Checkbox	True

Filled mandatory fields

passed

And And Click on "Next" button

clicked on the button :: Next

passed

And And Verify user has navigated to "Pre-requisite Information" page

passed

And And Verify "Pre-requisite Information" information of "Physician And Surgeon Limited License" intake flow

passed

And And Click on "Continue" button

clicked on the button :: Continue

passed

And And Verify user has navigated to "Demographic Information" page

passed

And And Answer "Yes" to this question "Have you ever been known under any other names? Will this application contain documents with your different name?"

passed

And And Verify the "presence" of below "fields":

Field Name

Alternate Names:

passed

And And Fill the below details :

Field Name	Data Type	Value
Alternate Names:	Text	test Alternate

Filled mandatory fields

passed

And And Check the status of "Mailing Address if different than above:" checkbox and make it "Unchecked"

passed

And And Verify the "Absence" of below fields in "Mailing Address if different than above:" section

Field Name	Data Type
Street	Text
City	Text
Country	Dropdown
State	Dropdown
Zip Code	Text
County	Text

passed

And And Check the status of "Mailing Address if different than above:" checkbox and make it "checked"

passed

And And Verify the "presence" of below fields in "Mailing Address if different than above:" section

Field Name	Data Type
Street	Text
City	Text
Country	Dropdown
State	Dropdown
Zip Code	Text
County	Text

passed

And And Fill the below details of "Mailing Address if different than above:" section :

Field Name	Data Type	Value
Country	Dropdown	United States

passed

And And Verify the "presence" of below fields in "Mailing Address if different than above:" section

Field Name	Data Type
State	Dropdown

passed

And And Fill the below details of "Mailing Address if different than above:" section :

Field Name	Data Type	Value
Country	Dropdown	Afghanistan

passed

And And Verify the "presence" of below fields in "Mailing Address if different than above:" section

Field Name	Data Type
State	Text

passed

And And Click on "Save & Next" button of "Demographic Information" page

passed

And And Verify user has navigated to "Personal Data Questions" page

passed

And And Click on "Save & Next" button of "Personal Data Questions" page

passed

And And Validate multiple error messages:

Error Message

Error: 1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety? is required.

Error: 2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety? is required.

Error: 3. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction? is required.

Error: 4a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes? is required.

Error: 4b. Diverted controlled substances or legend drugs? is required.

Error: 4c. Violated any drug law? is required.

Error: 4d. Prescribed controlled substances for yourself? is required.

Error: 5. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession? is required.

Error: 6. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority? is required.

Error: 7. Have you ever surrendered a license, certificate, registration, or other privilege to practice a healthcare profession, in connection with or to avoid action by state, federal, or foreign authority? is required.

Error: 8. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession? is required.

Error: 9. Have you had hospital privileges, medical society, other professional society or organization membership revoked, suspended, restricted or denied? is required.

Error: 10. Have you ever been the subject of any informal or formal disciplinary action related to the practice of medicine? is required.

Error: 11. To the best of your knowledge, are you the subject of an investigation by any licensing board as to the date of this application? is required.

Error: 12. Have you ever agreed to restrict, surrender, or resign your practice in lieu of or to avoid adverse action? is required.

Error: 13. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)? is required.

passed

And And Verify Help Text on PDQ Page

passed

And And Answer "Yes" to this question "1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety?"

passed

And And Fill the below details :

Field Name	Data Type	Value
1a. Please explain medical condition.	Textarea	test medical condition
1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition.	Textarea	Test reduced limitations
1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition.	Textarea	test manner of practice

Filled mandatory fields

passed

And And Answer "Yes" to this question "2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety?"

passed

And And Fill the below details :

Field Name	Data Type	Value
2a. Chemical Substance Explanation	Textarea	test Chemical Substance

Filled mandatory fields

passed

And And Answer "Yes" to this question "3. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction?"

passed

And And Fill the below details :

Field Name	Data Type	Value
3a. Conviction Explanation	Textarea	Test conviction

Filled mandatory fields

passed

And And Answer "Yes" to this question "4a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes?"

passed

And And Fill the below details :

Field Name	Data Type	Value
4a. Controlled Substance Explanation	Textarea	Test Controlled substance

Filled mandatory fields

passed

And And Answer "Yes" to this question "4b. Diverted controlled substances or legend drugs?"

passed

And And Fill the below details :

Field Name	Data Type	Value
4b. Criminal Proceedings Explanation	Textarea	test criminal proceedings

Filled mandatory fields

passed

And And Answer "Yes" to this question "4c. Violated any drug law?"

passed

And And Fill the below details :

Field Name	Data Type	Value
4c. Drug Law Violations Explanation	Textarea	Test drug laws

Filled mandatory fields

passed

And And Answer "Yes" to this question "4d. Prescribed controlled substances for yourself?"

passed

And And Fill the below details :

Field Name	Data Type	Value
4d. Self Prescribed Controlled Substance Explanation	Textarea	Test self prescribed

Filled mandatory fields

passed

And And Answer "Yes" to this question "5. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession?"

passed

And And Fill the below details :

Field Name	Data Type	Value
5a. Violation of State or Federal Law Explanation	Textarea	test violation of state

Filled mandatory fields

passed

And And Answer "Yes" to this question "6. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority?"

passed

And And Fill the below details :

Field Name	Data Type	Value
6a. License, Certificate, Registration Issue Explanation	Textarea	test 6a. License, Certificate, Registration Issue Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "7. Have you ever surrendered a license, certificate, registration, or other privilege to practice a healthcare profession, in connection with or to avoid action by state, federal, or foreign authority?"

passed

And And Fill the below details :

Field Name	Data Type	Value
7a. Surrender Explanation	Textarea	test 7a. Surrender Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "8. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession?"

passed

And And Fill the below details :

Field Name	Data Type	Value
8a. Civil Judgement Explanation	Textarea	test 8a. Civil Judgement Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "9. Have you had hospital privileges, medical society, other professional society or organization membership revoked, suspended, restricted or denied?"

passed

And And Fill the below details :

Field Name	Data Type	Value
9a. Please explain	Textarea	test 9a. Vulnerable Persons Disqualification Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "10. Have you ever been the subject of any informal or formal disciplinary action related to the practice of medicine?"

passed

And And Fill the below details :

Field Name	Data Type	Value
10a. Please explain	Textarea	test 10a. Vulnerable Persons Disqualification Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "11. To the best of your knowledge, are you the subject of an investigation by any licensing board as to the date of this application?"

passed

And And Fill the below details :

Field Name	Data Type	Value
11a. Please explain	Textarea	test 11a. Vulnerable Persons Disqualification Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "12. Have you ever agreed to restrict, surrender, or resign your practice in lieu of or to avoid adverse action?"

passed

And And Fill the below details :

Field Name	Data Type	Value
12a. Please explain	Textarea	test 12a. Vulnerable Persons Disqualification Explanation

Filled mandatory fields

passed

And And Answer "Yes" to this question "13. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)?"

passed

And And Fill the below details :

Field Name	Data Type	Value
13a. Please explain	Textarea	test 13a. Vulnerable Persons Disqualification Explanation

Filled mandatory fields

passed

And And Click on "Save & Next" button of "Personal Data Questions" page

passed

And And Verify user has navigated to "National Provider Identifier Number" page

passed

And And Fill the below details :

Field Name	Data Type	Value
1. Enter your National Provider Identifier (NPI) Number if available.	Text	123456

Filled mandatory fields

passed

And And Click on "Save & Next" button of "National Provider Identifier Number" page

passed

And And Verify the "presence" of error message :

Error Message

NPI is 10 digits.

passed

And And Fill the below details :

Field Name	Data Type	Value
1. Enter your National Provider Identifier (NPI) Number if available.	Text	1234567890

Filled mandatory fields

passed

And And Click on "Save & Next" button of "National Provider Identifier Number" page

passed

And And Verify the "Absence" of error message :

Error Message

NPI is 10 digits.

passed

And And Verify user has navigated to "Military Related Questions" page

passed

And And Select "No" for this question "Are you the spouse or registered domestic partner of military personnel?"

passed

And And Verify absence of text on Military Spouse or Registered Domestic Partner of Military Personnel page

passed

And And Select "Yes" for this question "Are you the spouse or registered domestic partner of military personnel?"

passed

And And Verify the text on "Military Related Questions" page of "Social Worker Associate Advanced License" intake flow

passed

And And Click on "Save & Next" button of "Military Related Questions" page

passed

And And Verify user has navigated to "Institution or Training Program Information" page

passed

And And Click on "Save & Next" button of "Institution or Training Program Information" page

passed

And And Validate multiple error messages:

Error Message

Error: Institution or Program Name is required.

Error: Address Line 1 is required.

Error: City is required.

Error: State or Province is required.

Error: Zip Code is required.

passed

And And Fill the below details :

Field Name	Data Type	Value
Institution or Program Name	Text	Test Program
Address Line 1	Text	Test Address Line 1
Address Line 2	Text	Test Address Line 2
City	Text	City test
State or Province	Dropdown without scroll	Alabama
Zip Code	Number	12345

Filled mandatory fields

passed

And And Click on "Save & Next" button of "Institution or Training Program Information" page

passed

And And Verify user has navigated to "Training & Education" page

passed

And And Create new "Training & Education"

passed

And And Click on "Save & Next" button of "Training & Education" page

passed

And And Verify the "presence" of error message :

Error Message

Please add at least one.

passed

And And Click on "Add" Hyperlink

passed

And And Click on "SUBMIT" button of "Training & Education" page

passed

And And Validate multiple error messages:

Error Message

Error: Country is required.

passed

And And Fill the below details :

Field Name	Data Type	Value
Country	Dropdown	United States

Filled mandatory fields

passed

And And Click on "SUBMIT" button of "Training & Education" page

passed

And And Validate multiple error messages:

Error Message

Error: State or Province is required.

Error: City is required.

Error: School or Training Program Name is required.

Error: School Type is required.

Error: Date From is required.

Error: Date To is required.

Error: Type of Degree is required.

Error: Attendance Status is required.

passed

And And Fill the below details :

Field Name	Data Type	Value
State or Province	Dropdown	Alabama
City	Text	test city
School or Training Program Name	Text	test School
School Type	Dropdown	College/University
Date From	Date	Today - 100
Date To	Date	Today - 0
Type of Degree	Text	Test Type of Degree
Attendance Status	Dropdown	Graduated

Filled mandatory fields

passed

And And Verify the "presence" of below "fields":

Field Name

Graduation Date

passed

And And Fill the below details :

Field Name	Data Type	Value
Attendance Status	Dropdown	Attending

Filled mandatory fields

passed

And And Verify the "Absence" of below "fields":

Field Name

Graduation Date

passed

And And Click on "SUBMIT" button of "Training & Education" page

passed

And And Verify the "presence" of below "link":

Link

Edit

Delete

passed

And And Click on "Save & Next" button of "Training & Education" page

passed

And And Verify user has navigated to "Post Graduate Training" page

passed

And And Click on "Add" Hyperlink

passed

And And Click on "SUBMIT" button of "Post Graduate Training" page

passed

And And Validate multiple error messages:

Error Message

Error: Post Graduate Training Program Name is required.

Error: Specialty is required.

Error: Start Date is required.

Error: End Date is required.

passed

And And Fill the below details :

Field Name	Data Type	Value
Post Graduate Training Program Name	Text	Test Program
Specialty	Text	Test Speciality
Start Date	Date	Today - 100
End Date	Date	Today + 80

Filled mandatory fields

passed

And And Click on "Save & Next" button of "Post Graduate Training" page

passed

And And Verify user has navigated to "Postgraduate Training Verification and Evaluation" page

passed

And And Verify the text on "Postgraduate Training Verification and Evaluation" page of "Physician And Surgeon Residency License" intake flow

passed

And And Click on "Next" button of "Postgraduate Training Verification and Evaluation" page

passed

And And Verify user has navigated to "Experience" page

passed

And And Verify the "presence" of below "text" having breaks:

Text

List in chronological order any professional experiences you have had since medical school, or the past 7 years, whichever is shorter. Exclude activities listed under other sections, identify any periods of time breaks of 90 days or more.

passed

And And Click on "Add" Hyperlink

passed

And And Click on "SUBMIT" button of "Experience" page

passed

And And Validate multiple error messages:

Error Message

Error: Business Name is required.

Error: Type of Experience/Specialty is required.

Error: City is required.

Error: Country is required.

passed

And And Fill the below details :

Field Name	Data Type	Value
Business Name	Text	Test Business Name
Type of Experience/Specialty	Text	test experiencee type
City	Text	test city
Country	Dropdown	United States

Filled mandatory fields

passed

And And Click on "SUBMIT" button of "Training & Education" page

passed

And And Validate multiple error messages:

Error Message

Error: State or Province is required.

Error: Start Date is required.

Error: End Date is required.

passed

And And Fill the below details :

Field Name	Data Type	Value
State or Province	Dropdown	Alabama
Start Date	Date	Today - 50
End Date	Date	Today - 0

Filled mandatory fields

passed

And And Click on "SUBMIT" button of "Experience" page

passed

And And Click on "Save & Next" button of "Experience" page

passed

And And Verify user has navigated to "Malpractice History" page

passed

And And Click on "Save & Next" button of "Malpractice History" page

passed

And And Validate multiple error messages:

Error Message

Error: Have you been named in any medical malpractice lawsuits? is required.

passed

And And Answer "Yes" to this question "Have you been named in any medical malpractice lawsuits?"

passed

And And Verify the "presence" of below "text" having breaks:

Text

You must include copies of the settlement or final disposition. If pending, indicate status.

passed

And And Verify the text on "Malpractice History" page of "Physician And Surgeon Residency License" intake flow

passed

And And Click on "Save & Next" button of "Malpractice History" page

passed

And And Verify user has navigated to "Limited License Type" page

passed

And And Verify the "presence" of below "text" having breaks:

Text

For more information about the limited license categories, please see the

Medical Commission website

passed

And And Fill the below details :

Field Name	Data Type	Value
Resident Physician	Checkbox	True

Filled mandatory fields

passed

And And Verify the text on "Limited License Type-Resident Physician" page of "Physician And Surgeon Residency License" intake flow

passed

And And Click on "Save & Next" button of "Limited License Type" page

passed

And And Verify user has navigated to "Supporting Documentation" page

passed

And And Verify the "presence" of below "text":

Text

Are you the spouse or registered domestic partner of military personnel?

passed

And And Verify the "presence" of below "text" having breaks:

Text

Based on your responses the following documentation is needed to support your applications review. If you do not have these listed documents currently you can submit the application and return to this page to upload the documents. Please note that once you upload a document you cannot delete it. A review must occur first before a replacement document can be uploaded. This may delay the processing time of your application. Please double check the document is correct before uploading.

Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction?

Please attach certified copies of all court documents related to your criminal history with your application.

Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a health care profession?

Please attach copies of all judgements, decisions, and agreements.

passed

And And Verify the text on "Supporting Documentation" page of "Physician And Surgeon Residency License" intake flow

passed

And And Click on "Save & Next" button of "Supporting Documentation" page

passed

And And Verify user has navigated to "Additional Information" page

passed

And And Verify the "presence" of below "Section":

Section Name

Official Transcripts

Postgraduate Training Program Director Verification and Evaluation of Training Form

Resident Physician Appointment Verification Form

Additional Information

passed

And And Verify the text on Additional Information Page of "Physician And Surgeon Residency License"

passed

And And Click on "Next" button of "Additional Information" page

passed

And And Verify user has navigated to "Attestation" page

passed

And And Verify the "presence" of below "text":

Text

I understand the Department of Health may require more information before deciding on my application. The department may independently check conviction records with state or federal databases.

I authorize the release of any files or records the department requires to process this application. This includes information from all hospitals, educational or other organizations, my references, and past and present employers and business and professional associates. It also includes information from federal, state, local or foreign government agencies.

I understand I must inform the department of any past, current or future criminal charges or convictions. I will also inform the department of any physical or mental conditions that jeopardize my ability to provide quality health care. If requested, I will authorize my health providers to release to the department information on my health, including mental health and any substance abuse treatment.

passed

And And Verify the text on Attestation page

passed

And And Fill the below details :

Field Name	Data Type	Value
I agree.	Checkbox	true

Filled mandatory fields

passed

And And Click on "Save & Next" button of "Attestation" page

passed

And And Verify user has navigated to "Review" page

passed

And And Verify the details in Review Page

Field Name

1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety?

2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety?

3. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction?

4a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes?

4b. Diverted controlled substances or legend drugs?

4c. Violated any drug law?

4d. Prescribed controlled substances for yourself?

5. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession?

6. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority?

7. Have you ever surrendered a license, certificate, registration, or other privilege to practice a healthcare profession, in connection with or to avoid action by state, federal, or foreign authority?

8. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession?

9. Have you had hospital privileges, medical society, other professional society or organization membership revoked, suspended, restricted or denied?

10. Have you ever been the subject of any informal or formal disciplinary action related to the practice of medicine?

11. To the best of your knowledge, are you the subject of an investigation by any licensing board as to the date of this application?

12. Have you ever agreed to restrict, surrender, or resign your practice in lieu of or to avoid adverse action?

13. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)?

1. Enter your National Provider Identifier (NPI) Number if available.

Are you the spouse or registered domestic partner of military personnel?

State or Province

City

School or Training Program Name

School Type

Date From

Date To

Type of Degree

Attendance Status

passed

And And Store the saved values on Review Page

Field Name

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Social Security Number

Gender

Street

City

Country

State

Zip Code

County

Phone Number

Cell Number

Email Address

passed

And And Verify presence of "Edit" button of "Personal Data Questions" section in review

passed

And And Verify presence of "Edit" button of "National Provider Identifier Number" section in review

passed

And And Verify presence of "Edit" button of "Military Related Questions" section in review

passed

And And Verify presence of "Edit" button of "Institution or Training Program Information" section in review

passed

And And Verify presence of "Edit" button of "Training & Education" section in review

passed

And And Verify presence of "Edit" button of "Experience" section in review

passed

And And Verify presence of "Edit" button of "Post Graduate Training" section in review

passed

And And Verify presence of "Edit" button of "Malpractice History" section in review

passed

And And Verify presence of "Edit" button of "Limited License Type" section in review

passed

And And Verify presence of "Edit" button of "Supporting Documentation" section in review

passed

And And Verify presence of "Edit" button of "Attestation" section in review

passed

And And Click on "Save & Next" button of "Review" page

passed

And And Verify user has navigated to "Payment" page

passed

And And Validate "Application Fee" fee is "$325.00" for "Radiologist Assistant Certification" Intake flow

passed

And And Validate "Substance Abuse monitoring Fee" fee is "$50.00" for "Radiologist Assistant Certification" Intake flow

passed

And And Verify the "presence" of below "text":

Text

There is a $2.50 convenience fee required to use the online service when paying by credit card/debit card. The amount will be charged in addition to your fee(s). There is no additional convenience fee for ACH payments.

Fees submitted with applications for initial credentialing, examinations, renewal and other fees associated with the licensing and regulation of the profession are nonrefundable.

passed

And And Verify the "presence" of below "link":

Link

WAC 246-12-340.

passed

And And Verify the "presence" of below "button":

Button Name

Pay & Submit

passed

And And Click on "Pay & Submit" button of "Payment" page

passed

And And Click on "SUBMIT" button of "Confirmation" page

passed

And And Click on "Submit Payment" button

clicked on the button :: Submit Payment

passed

And And Get Application Id from the URL

passed

And And Navigate to Application URL

passed

And And Click on "Related" Hyperlink

passed

And And Click on hyperlink that contains "IA-"

passed

And And Click on "Application Form" Hyperlink

passed

And And Verify the values of below fields in Backend

Field Name

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Social Security Number

Gender

Street

City

Country

State

Zip Code

County

Phone Number

Cell Number

Email Address

1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety?

1a. Please explain medical condition.

1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition.

1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition.

2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety?

2a. Chemical Substance Explanation

3. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction?

3a. Conviction Explanation

4a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes?

4a. Controlled Substance Explanation

4b. Diverted controlled substances or legend drugs?

4b. Criminal Proceedings Explanation

4c. Violated any drug law?

4c. Drug Law Violations Explanation

4d. Prescribed controlled substances for yourself?

4d. Self Prescribed Controlled Substance Explanation

5. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession?

5a. Violation of State or Federal Law Explanation

6. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority?

6a. License, Certificate, Registration Issue Explanation

7. Have you ever surrendered a license, certificate, registration, or other privilege to practice a healthcare profession, in connection with or to avoid action by state, federal, or foreign authority?

7a. Surrender Explanation

8. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession?

8a. Civil Judgement Explanation

9. Have you had hospital privileges, medical society, other professional society or organization membership revoked, suspended, restricted or denied?

9a. Please explain

10. Have you ever been the subject of any informal or formal disciplinary action related to the practice of medicine?

10a. Please explain

11. To the best of your knowledge, are you the subject of an investigation by any licensing board as to the date of this application?

11a. Please explain

12. Have you ever agreed to restrict, surrender, or resign your practice in lieu of or to avoid adverse action?

12a. Please explain

13. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)?

13a. Please explain

1. Enter your National Provider Identifier (NPI) Number if available.

Are you the spouse or registered domestic partner of military personnel?

State or Province

passed

And And Logout of the salesforce application

Logout of the application

passed

Name	Value
User Name	prince.gupta_mtxb2b
Time Zone	Asia/Calcutta
Machine	Windows 10 - 64 Bit
Selenium	3.7.0
Maven	3.6.3
Java Version	1.8.0_151

Features

Categories

Dashboard